Association of Urinary Tract Infection and Reflux with Uninhibited Bladder Contractions and Voluntary Sphincteric Obstruction

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Abstract
Neurologically normal children (53) with recurrent urinary tract infection who had bladder-sphincter incoordination characterized by voluntary sphincteric constriction during involuntary, uninhibited bladder contraction were studied. Increased intravesical pressure was documented during these events and associated with vesicoureteral reflux in nearly 50% of the children and with ureteral orifice abnormalities in 30% of those without reflux. Increased intravesical pressure may cause urinary infection in these children and may produce a spectrum of intravesical anatomic distortion that predisposes to vesicoureteral reflux. In a prospective uncontrolled study, treatment of uninhibited bladder contractions allowed 58% of the patients to maintain sterile urine without subsequent antimicrobial therapy after cure of the initial infection.

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